探讨超声造影诊断儿童肝移植术后肝动脉闭塞（HAO）的效能并总结进一步常规超声随访中HAO相关并发症（肝内坏死灶和胆道并发症）的发生率。

回顾性选取2013年6月至2019年6月首都医科大学附属北京友谊医院肝移植中心633例肝移植患儿的资料，术后常规超声可疑HAO则行超声造影检查，采用四格表分析超声造影诊断HAO的准确性、敏感度、特异度，HAO的确诊标准包括手术证实、数字减影血管造影（DSA）/计算机断层扫描血管造影（CTA）和随访。另外，总结进一步常规超声随访中HAO相关并发症（肝内坏死灶及胆道并发症）的发生率。

共42例患儿术后常规超声可疑HAO行超声造影检查，经确诊标准共诊断HAO患儿33例，其中1例为晚发（发生在肝移植术后5个月）。超声造影诊断34例HAO，其中有1例在随后的DSA检查中提示为肝动脉吻合口部分血栓形成，除外动脉闭塞；超声造影诊断肝动脉正常6例，在随访中也均正常；超声造影诊断肝动脉狭窄2例，随后由CTA检查证实，予以剔除。超声造影诊断HAO的准确性为97.5%（39/40），敏感度为100%（33/33），特异度为85.7%（6/7）。常规超声观察HAO后侧支循环形成的时间为闭塞后11（10，14）d，结合超声及其他影像学检查（CT/MRI），33例HAO患儿中，出现肝内缺血坏死灶15例（45.5%）、胆汁瘤5例（15.1%）、胆漏1例（3.0%）、坏死性胆管炎9例（27.3%）、单纯肝内三级胆管扩张2例（6.1%）。

超声造影诊断儿童肝移植术后HAO的准确性和敏感度很高，可以比较准确地评价肝动脉的情况，当超声造影发现肝动脉正常时，可以避免患者进行不必要的DSA检查，但当超声造影提示HAO时，需要行DSA验证以避免不必要的开腹探查。另外，超声造影在HAO相关并发症的随访中也具有重要作用。

To investigate the efficiency of contrast-enhanced ultrasound (CEUS) in the diagnosis of hepatic artery occlusion (HAO) and record the incidence of HAO-related complications (intrahepatic necrosis and biliary complications) during further conventional ultrasound follow-up.

The data of 633 patients who underwent pediatric liver transplantation was retrospectively selected. CEUS was performed in cases with suspicious HAO based on conventional ultrasound. The accuracy, sensitivity, and specificity of CEUS for diagnosis of HAO were analyzed using the fourfold table. The diagnostic criteria for HAO included surgery, digital subtraction angiography (DSA)/computed tomography angiography (CTA), and follow-up (persistent no flow or progressive change from tardus parvus waveform to no flow on Doppler US follow-up studies associated with the development of ischemic necrosis or a nonanastomotic biliary complication, such as bile duct necrosis/biloma/bile leakage). The incidence of HAO-related complications (intrahepatic necrosis and biliary complications) during further conventional ultrasound follow-up was also recorded.

CEUS was performed in 42 children with suspected HAO based on conventional ultrasound. Thirty-three HAOs, including one late HAO (5 months after liver transplantation), met the diagnostic criteria for HAO. Among the 34 HAOs diagnosed by CEUS, one showed partial thrombosis at the anastomotic site of the hepatic artery on subsequent DSA, for which HAO was excluded; six with negative CEUS findings were confirmed by the clinical follow-up; the other two were ruled out because hepatic artery stenosis (HAS) was diagnosed by CEUS and confirmed by CTA. The accuracy, sensitivity, and specificity of CEUS in diagnosing HAO were 97.5% (39/40), 100% (33/33), and 85.7% (6/7), respectively. The formation of collateral circulation after hepatic artery occlusion was observed by conventional ultrasound for 11 (10-14) days. Based on ultrasound and other imaging examinations (CT/MRI), among the 33 patients with hepatic artery occlusion, 15 had intrahepatic ischemia lesions (45.5%), 5 had choloma (15.1%), 1 had biliary leakage (3.0%), 9 had ischemic cholangitis (27.3%), and 2 had simple third-grade intrahepatic bile duct dilatation (6.1%).

CEUS shows a high accuracy and sensitivity in the diagnosis of HAO. Negative CEUS findings will avoid invasive angiography; however, when CEUS indicates HAO, DSA should be performed for verification to avoid unnecessary surgery. In addition, ultrasound plays an important role in the follow-up of complications associated with hepatic artery occlusion.